Medicare claims for electrodiagnostic testing may be riddled with fraud, waste and abuse. More than 4,900 doctors filed questionable claims totaling $139 million in 2011 for these tests, according to an Office of Investigations report released this month.
Medical professionals use electrodiagnostic procedures such as nerve conduction tests (NCT) and needle electromyography (EMG) to evaluate patients who may have nerve damage. EMG sensors, for example, can track muscle activity around a fracture site to determine how much mobility a patient has in an affected area, as FierceMobileHealthCare reported.
Problem billings found in the study clustered around New York City, Los Angeles and Houston. About 20 percent of providers who filed questionable claims received comparative billing reports from the Centers for Medicare & Medicaid Services in 2011 based on their 2010 claims histories for the procedures, the OIG noted. Apparently the doctors didn't scale back their billing for electrodiagnostic tests even after learning their utilization patterns deviated from national specialty norms.
Moreover, the OIG spotted other red flags with these services: Part B spending on electrodiagnostic testing jumped 74 percent from 2002 to 2011, outdistancing overall Medicare spending growth. The program paid about $486 million in 2011 to 21,700 doctors who billed for electrodiagnostic tests on behalf of 877,000 beneficiaries. And claims for these tests were part of a Medicare Strike Force investigation that charged doctors with billing $113 million in false claims, the report stated.
In light of these findings, the OIG recommended CMS ramp up its monitoring of electrodiagnostic test claims, educate providers about appropriate filing for these tests and act against problem billers.
Relatedly, the government has contained Medicaid spending for electrodiagnostic testing. Neurologists last year faced Medicaid pay cuts of up to 7 percent largely due to reduced allowances for EMG and NCT, as FierceHealthcare reported.
- here's the OIG report (.pdf)